The public health crisis brewing behind bars

Incarceration in the United States is something of a manufactured disease and epidemic. Those convicted lose their rights in a penal system which, by definition, is punishment. They must “pay for” their crimes, and whether the criminal justice system intended it or not, convicts pay with their health. 

Correctional facilities are often unsanitary, violent, and lacking in adequate healthcare. Naturally, those in confinement are left with physical and psychological scars. According to the U.S. Office of Disease Prevention and Health Promotion, incarcerated people are at higher risk of hypertension, asthma, cancer, and arthritis compared to the rest of the population. Medical care in detention is scant, so releasees often return home saddled with a suite of health challenges that need urgent attention.

Prison punishes offenders for longer than their time served. New research presented at the Epidemiology-Lifestyle conference last March piles evidence onto the long-term health impacts of lockup, this time from a cardiovascular perspective. The study team led by Yale University data analyst Jenerius Aminawung tracked the health of over 400 former prisoners that were newly released from jails and prisons across Connecticut. Up to a year after emancipation, the effects of confinement still lingered: these people tended to have higher blood pressure, blood sugar levels, and body mass indices than the population average. While people who are incarcerated often have pre-existing health issues, previous studies have shown that being in the stressful environment of detention can perpetuate those conditions or worsen them. Aminawung’s team also observed that study participants were also more likely to adopt unhealthy habits such as smoking and sedentariness compared to those who had never known confinement. Overall, incarceration put people on the path toward poorer cardiovascular health, an indelible shadow of the prison walls that they left behind.  

Adding to the health challenges of former detainees is the whole gamut of structural problems of an inequitable society. This group often faces employment discrimination and unstable housing, factors that could impact healthcare access and the quality of life. 

Incarceration is a burgeoning public health crisis in the US simply because of the sheer number of people shuffling in and out of the correctional system. The US has one of the highest per population rates of incarceration in the world. On any given day, over two million people sit behind bars. 

A large number of people packed into close quarters spells another kind of public health disaster. Infectious diseases are quick to spread when people are living in crowded facilities, in cells that are just six feet wide for days on end. In the first year of the pandemic, the COVID-19 infection rate in prison populations was five to six times higher than that of the outside world; the mortality rate was double to triple. Wrote the criminologist Jeffrey Ian Ross, incarceration “is increasingly like a death sentence.” 

Overall, incarceration put people on the path toward poorer cardiovascular health, an indelible shadow of the prison walls that they left behind.

The story here isn’t just about how incarceration is cooking up a public health crisis. The larger issue at hand is about how incarceration exacerbates health inequities, simply because the people in penitentiary are disproportionately Black and Latinx. 

“This burden of incarceration is disproportionately borne by minoritized and poor communities,” study author Aminawung said at the conference. One in five Black men and one in eight Latino men will see the insides of a prison in their lifetime. 

“The ultimate question when we observe racial differences in health outcomes, especially between Black and white in the United States, and especially for men, is, how much of those racial disparities may be explained by a large percentage of the Black men population having a history of incarceration?” says Evan Thacker, a chronic disease epidemiologist at Brigham Young University who wasn’t involved in the research. Right now, health researchers usually don’t factor in a person’s incarceration history in analyzing health trends. That could mean a large part of the picture is missing when it comes to understanding the nuances in population health. Aminawung’s research caused Thacker to wonder, “as we continue with epidemiologic studies of racial differences in health,” he says, “how important is it for us to collect information about the history of incarceration?”

Here’s the coup de grâce: incarceration doesn’t really deter crime or rehabilitate the criminal to begin with. Over two-thirds of erstwhile prisoners will be rearrested for another crime within three years of their release. The US Department of Justice even notes that inmates exchange crime strategies in jail, setting the stage for future offenses. 

Incarceration doesn’t quite reduce the problem of crime and adds another. While the effectiveness of incarceration as a sentence and deterrence is an issue for another day, the more urgent question is how to lessen incarceration’s negative impacts in the first place. On the issue of health justice, prisons should serve up better primary care for their wards as well as offer better living environments along the lines of higher quality sleep and diets. For the newly released, coordinated follow-up care from community health groups and hospitals can ensure that former inmates receive the medical support they need to dilute the health hit they sustained while behind bars. Ultimately, a more humane approach to incarceration will help these people integrate into society if they’re not left too much wanting.